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Applicant Information

Employment Desired
Part Time Full Time Temporary
Monday Tuesday Wednesday Thursday
Friday Saturday Sunday
Yes No
Yes No
Yes No

Education
Grammar School
High School
College

Special Skills
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Yes No

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and understanding, that if employed, falsified statement on this application shall be ground for dismissal. I authorized all investigation of statement contained herein and the references and employers I listed, to give you any/ all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative.

I consent to the collection, use, storage, and processing of my personal and, where applicable, health-related information, including any data I submit on behalf of others, for the purpose of evaluating or fulfilling my request made through this form. I understand this will be handled in accordance with the Privacy Policy.